MEDICARE: MOIRA THERESE YANIK M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	15917	OR

General Provider Information

NPI Number	:	1659821726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOIRA THERESE YANIK M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	31 DORCHESTER DR
Second Line	:
City	:	DALLAS
State	:	PA
Zip	:	18612-1401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 DORCHESTER DR
Second Line	:
City	:	DALLAS
State	:	PA
Zip	:	18612-1401
Country	:	US
Telephone Number	:	570-423-5607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2016
Last Update Date	:	10/12/2016

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Directions to “ MOIRA THERESE YANIK M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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